Angela Towler is proof that injury need not destroy a career

Angela Towler, a petite blonde who looks much younger than her 38 years, seems so fragile in the shirt dress draped over her slender frame that one can’t help thinking she might break at the slightest touch. Appearances are deceptive, though: Angela, a leading light at the legendary Rambert Dance Company, has the muscle definition of an Olympic athlete and a pain threshold so high, it amazes her doctors.

Both qualities are a useful asset for a contemporary dancer. Angela regularly endures a punishing schedule of eight hours’ intense training every day, plus, when touring, a three-hour performance every evening. She has danced on broken toes, through colds and flu, and performed for weeks with a torn ligament in her shoulder.

But even she could not tolerate the excruciating pain that developed after damaging her hip during some particularly demanding dance moves in 2009. Earlier this year she had a hip replacement – and, astonishingly, is now back on stage. She is one of the few contemporary dancers to admit she has suffered injury.

The news two weeks ago that the Strictly Come Dancing judge Craig Revel Horwood, who is classically trained, is to undergo hip-replacement surgery, has highlighted that professional dancers are at high risk of damage to the joints. Yet Angela says a culture of secrecy means that to admit to any damage risks being branded “fragile” – a euphemism for on the way out.

Angela, then 34, knew she had crossed her pain threshold during a rehearsal of A Linha Curva, a highly demanding modern ballet by the Israeli choreographer Itzik Galili. It required her repeatedly to perform the splits upside down, kicking her right leg above her head. Suddenly she felt “a sharp pain tearing through my left thigh, up to my groin. It felt as if my leg was on fire.” After gasping in agony, she displayed her characteristic “the show must go on” spirit and resumed her rehearsal. “The pain was acute, but I kept telling myself, 'It’s muscle strain, that’s all.’ ”

She was, she admits, “in denial; I didn’t want to see my GP. He would have told me to take six weeks off – and that just wasn’t an option. I would risk losing my job.”

Angela soldiered on for the rest of that season but by the summer break the pain had grown unbearable. Paul Morrissey, the osteopath who has worked with her during her 20-year career, organised an MRI scan which showed the dancer had torn the labrum, the ring of cartilage surrounding her left hip joint, which helps with shock absorption and lubrication of the joint. Such tears are common among the elderly, top athletes and dancers. Morrissey advised Angela to see Professor Fares Haddad, a consultant orthopaedic and trauma surgeon at the Princess Grace Hospital, London. Haddad says he has seen a number of dancers in their thirties showing an “increased risk of premature hip wear and osteoarthritis. Many of them are single-minded and extremely strong individuals who are able to continue performing in spite of degenerative changes in their hips.” But eventually, Prof Haddad stresses, even the most driven individuals “succumb in terms of their range of movement and their ability to perform, and require hip arthroplasty”.

He explained to Angela that she needed a hip replacement; the scan had revealed not only cartilage damage but extensive arthritic inflammation of the joint.

Angela refused. She was too young, she thought, and convinced herself that she could ignore the pain and keep dancing, with her osteopath’s support. By 2012 the hip had grown so painful she was taking huge amounts of pain killers every four hours. “The pain meant most nights I only had two hours’ sleep. I was exhausted: even putting on my shoes was agony.”

As well as the pain, Angela was tormented by the prospect of having to give up dancing: “It was my life. I was scared I would lose my identity.”

She felt she could not discuss her fears with colleagues. Although no reliable statistics exist, it’s thought that osteoarthritis is common among dancers – though performers rarely own up to it. “I felt so alone,” says Angela. “There was no safety net.”

Ali Joy, doctor at the Royal Ballet School, says: “Top athletes have a psychotherapist, nutritionist, trainer, and physiotherapist catering for their needs. They go to the front of the queue for every NHS treatment, consultation and operation. But dancers, even though they, too, are extraordinary athletes, have no such support.”

It took three years from diagnosis for Angela to go back to Prof Haddad for a hip replacement. “He told me he was surprised I’d held out for so long.”

In January this year she underwent a total hip arthroplasty, in which her damaged left joint was replaced with a prosthetic ball and socket. Surgeons normally make an incision of about

8-12in above the hip to perform this, but she had minimally invasive surgery in which the cut is smaller and specialised instruments passed through it to perform the surgery. It took 45 minutes.

“The night after the op the left thigh was all swollen because that was where they had put in a pin,” says Angela. “I stared at the scar: I regretted it, I was terrified, I couldn’t stop crying.”

Determined to get back on her feet again, she drew up a strict rehab schedule. The first days, she moved about on crutches but by week two she was taking her first tentative steps without them. By week three she was doing stretching exercises for both upper and lower body. “I was tough on myself, but I figured that the more I moved the quicker I’d recover.”

Within three months, she was able to do a wide range of exercises – if not yet the plié or the splits.

Despite her progress, Angela worried that, as the company knew she had had a hip replacement, “they’d think twice about having me back. Who had ever heard of a dancer with a new hip performing again?”

Thankfully, Mark Baldwin, the Rambert Dance Company director, offered her the chance to go back as rehearsal director last summer. While working, she continued training. A few months in, she was finally able to do the plié, and even the splits, for the first time in three years. Her reward followed: Baldwin has asked her to perform in this season’s forthcoming L’Apres Midi d’un Faun.

“I hope it’s the first of many roles,” she says.

Dr Joy says that Angela is the first dancer she knows of to get back on stage after a hip replacement. “It’s a fantastic example of sheer determination. But no one should have to do that all on their own – if dancers could have a fraction of the physical and psychological support athletes enjoy, we wouldn’t see so many stars forced to retire because of an injury.”

Angela agrees. “I’d like to tell dancers not to be scared. Admitting to an injury is not an admission of failure. It should not put you on the professional scrap heap.”